Document Detail


Effects of pain and prescription opioid use on outcomes in a collaborative care intervention for anxiety.
MedLine Citation:
PMID:  23370069     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine the effects of pain and opioid pain medication use on clinical and functional outcomes in 1004 primary care patients with an anxiety disorder randomized to receive the Coordinated Anxiety Learning and Management (CALM) collaborative care intervention (cognitive-behavioral therapy and/or medication) versus usual care.
METHODS: A total of 1004 patients with panic disorder, generalized anxiety disorder, social anxiety disorder, or posttraumatic stress disorder were randomized to CALM or usual care. Outcomes at 6, 12, and 18 months were compared in patients with and without moderate pain interference (for the entire anxiety disorder group and then just those with comorbid major depression) and in patients taking and not taking opioid medication (entire group, just those with comorbid major depression, and just those with moderate pain interference).
RESULTS: Patients with pain interference and patients taking opioid pain medication were more anxious [Brief Symptom Inventory anxiety subscale] and disabled (Sheehan Disability) at baseline, improved over time at similar rates, but at 18 months had lower response and remission rates. There was no moderating effect on the intervention. In patients with comorbid major depression, patients using opioid medications showed a trend for less disability improvement over time, and in patients with pain, patients using opioids showed less sustained anxiety response at 18 months.
CONCLUSIONS: Anxious patients with pain benefit as much as those without pain from cognitive-behavioral therapy and medication treatment. Among patients with pain, however, there is some evidence of a reduced anxiety treatment response in those taking opioid medication, which should be further studied.
Authors:
Peter Roy-Byrne; Mark D Sullivan; Cathy D Sherbourne; Daniela Golinelli; Michelle G Craske; Greer Sullivan; Murray B Stein
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The Clinical journal of pain     Volume:  29     ISSN:  1536-5409     ISO Abbreviation:  Clin J Pain     Publication Date:  2013 Sep 
Date Detail:
Created Date:  2013-08-05     Completed Date:  2014-02-28     Revised Date:  2014-05-05    
Medline Journal Info:
Nlm Unique ID:  8507389     Medline TA:  Clin J Pain     Country:  United States    
Other Details:
Languages:  eng     Pagination:  800-6     Citation Subset:  IM    
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00347269
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Analgesics, Opioid / adverse effects,  therapeutic use*
Anxiety / epidemiology,  therapy*
Cognitive Therapy / methods
Female
Follow-Up Studies
Humans
Male
Middle Aged
Pain / drug therapy*,  epidemiology
Pain Measurement
Prescription Drugs* / therapeutic use
Primary Health Care
Time Factors
Young Adult
Grant Support
ID/Acronym/Agency:
K24 MH065324/MH/NIMH NIH HHS; K24 MH065324/MH/NIMH NIH HHS; K24 MH64122/MH/NIMH NIH HHS; R01 DA022560/DA/NIDA NIH HHS; U01 MH057835/MH/NIMH NIH HHS; U01 MH057858/MH/NIMH NIH HHS; U01 MH057858/MH/NIMH NIH HHS; U01 MH058915/MH/NIMH NIH HHS; U01 MH070018/MH/NIMH NIH HHS; U01 MH070022/MH/NIMH NIH HHS
Chemical
Reg. No./Substance:
0/Analgesics, Opioid; 0/Prescription Drugs

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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